Clinical Nutrition ESPEN · Oct 26, 2026

Evaluation of the Geriatric Nutritional Risk Index as a marker of association of diabetic foot ulceration in patients on chronic haemodialysis: A retrospective cohort study

By Alberto-Rodríguez V, García-Álvarez Y, Álvaro-Afonso FJ et al.

BACKGROUND AND AIMS: Diabetic patients on haemodialysis (HD) are vulnerable to protein-energy wasting (PEW) and severe microvascular complications. Although the Geriatric Nutritional Risk Index (GNRI) is widely used to assess nutritional status in chronic kidney disease (CKD), its value as a comprehensive marker for clinical deterioration and disease progression of diabetic foot (DF) within this cohort remains largely unexplored. Here, we evaluate baseline nutritional status via the GNRI and determine its prospective association with adverse clinical trajectories, localised complications, and secondary morbidities in diabetic patients on chronic HD. METHODS: This retrospective, longitudinal cohort study focused on 53 adult patients with diabetes mellitus in a chronic HD program between May 2017 and November 2024. Nutritional status was evaluated using the GNRI equation adapted to HD, using a cut-off point of ≤91.2 to identify malnutrition or high nutritional risk. Clinical history, biochemical parameters, longitudinal nutritional evolution, and DF-related events (hospitalisations and amputations) were recorded over a 12-month follow-up period, whereas all-cause mortality was tracked throughout the entire study observation period (up to 6 years). Multivariate binary logistic regression, multiple linear regression, and Kaplan-Meier survival models were applied. RESULTS: The prevalence of DF was 41.5% (n=22). Patients with DF presented significantly lower baseline GNRI values compared with individuals without DF (90.49±7.49 vs. 96.06±5.54; p=0.003). Multivariate binary logistic regression revealed that baseline GNRI was independently and inversely associated with the presence of DF (OR=0.803; 95% CI: 0.682-0.946; p=0.009), indicating a 19.7% reduction in the probability of presenting DF for each one-unit increase in the GNRI. Lower GNRI values correlated significantly with a larger number of hospital admissions ( =-0.468; p<0.001) and a higher frequency of minor distal amputations ( =-0.284; p=0.039). Furthermore, Kaplan-Meier analysis showed that patients with baseline malnutrition had significantly lower survival over time compared with well-nourished individuals (Log-Rank p<0.001). According to multiple linear regression, body mass index (p=0.041), haemoglobin (p=0.036), and serum creatinine (p=0.004) were independently and positively associated with the GNRI. CONCLUSIONS: Malnutrition evaluated by the GNRI is highly prevalent and independently associated with an adverse clinical trajectory in diabetic patients on chronic HD. The GNRI serves as a robust marker of severe secondary outcomes, significantly correlating with higher hospitalisation rates, minor distal amputations, and overall mortality. Ultimately, the GNRI constitutes a simple, reproducible, and comprehensive tool for nutritional risk stratification and the optimisation of multi-disciplinary preventive strategies in this high-risk population.

doi.org/10.1016/j.clnesp.2026.105213PubMed 42933604Biomarkers